Frequently, during minimally invasive procedures several trocars are placed through the patient's body for access into a cavity therein. One trocar could provide illumination and video, another insuffiation and another minimally invasive operative instruments.
Surgery through a trocar inserted opening through for example, the tissue of the patient's abdominal wall has become an important means to minimize the extent of surgical invasion. The lessening of invasion improves the cosmetic result, shortens recovery and lowers the cost. Minimally invasive internal surgical procedures and equipment are available and in use for a variety of medical operations including gall bladder, bowel and gynecological surgery. A proper and simple instrument to retract and dissect through the opening is needed.
Tension on tissue is the fundamental tenet of all surgical technique. When the dissection field is held under tension, tissue being cut readily spreads away from the cutting tool. This allows for the safe and rapid identification of underlying structures, and provides a clear dissection path through which the surgeon can focus in on the deeper target.
In the minimally invasive setting, with as few as three instrument carrying openings or portals into the abdomen, the ability to cut tissue under tension is currently not feasible. The two instruments in use are often taken up holding larger structures (i.e., the gallbladder, or bowel) out of the way. This compels the surgeon to bite and tear away the overlying friable fascia using forceps, leaving clumps of tissue and debris at the sides of the microsurgical site. Often, underlying structures are inadvertently cut or misidentified due to the inability of the surgeon to create tension at the site.
If the surgeon had a reliable way of placing tension on the tissue at the wound, without giving up other instrumentation or creating another transabdominal puncture, this could reduce significantly the number of bile duct and vascular injury complications, and increase the ease with which the procedure is accomplished. Bile duct injuries occur at a rate of 0.2 to 3%, are a serious complication when present, and sometimes require open surgical revision.
Currently, disposable minimally invasive graspers and dissectors for laparoscopy account for millions in sales, with strong growth expected.
There is a wide variety of generic scissors and grasping forceps, as well as some slightly more specialized tools intended for grasping specific organs such as the gall bladder or bowel. Less invasive or minimally invasive surgical procedures are growing in frequency of use and complexity. Such procedures include: laparoscopy, thoracoscopy, endoscopy, etc.